Zoledronate-Induced Large Vessel Vasculitis Diagnosed by PET/CT
, Olga Vinogradskaya 1, Evgeniia Bublik 1, Maria Shmyreva 1, Gregory Koroba 1, Alexander Farmanov 1,3, Irakliy Aslanidis 4, Diana Pursanova 4, Veronica Manukova 4, Alexey Zilov 1,3 and Alexey Zhivov 1
Round 1
Reviewer 1 Report
The aim of the article is to report a possible rare side effect secondary to zoledronic acid infusion, while also considering the cause of the patient's osteoporosis.
The hypothesis tested is plausible and the methodology adopted for the diagnostic pathway is consistent with the clinical suspicion, although biopsy was not performed, but, even in the other two cases reported, the diagnosis of GCA was established even without histopathological evidence.
The topic has modest scientific relevance, but the case is treated with thoroughness showing good knowledge of the literature with appropriateness of references.
Figures are appropriate and understandable.
Conclusions are consistent with the evidence and arguments presented, and bibliographic references are relevant but not all recent. Conclusions are consistent and supported by the listed citations.
I suggest that the authors improve the language with the help of someone with full professional competence in English
Author Response
Dear reviewer, thank you for your comments
Yes, biopsy was not performed like as in the other mentioned cases in our manuscript
We corrected the language in the manuscript.
Reviewer 2 Report
-First of all, we would like to thank the authors for reporting a rare case of an adverse effect of zolendrate acid use associated with large vessel vasculitis.
It is a well-structured, clear case with a very interesting discussion. However, I will try to make some recommendations for improvement.
-Zoledronic acid is used to treat and prevent multiple forms of osteoporosis, hypercalcemia of malignancy, multiple myeloma, bone metastases from solid tumors, and Paget's disease of bone.
Because of its IV presentation, it is not indicated as a first choice in the management of osteoporosis. Since it has an IV presentation, it is not indicated as a first choice in the management of osteoporosis.
It is also known for its high risk of AKI and other complications documented in the manuscript. I recommend specifying the reason for choosing this bisphosphonate.
-The introduction should comment on the main recommendations for the use of bisphosphonates according to the clinical guidelines for the management of osteoporosis of the American Society of Rheumatology.
The paragraph from lines 56 to 62 should be summarized or deleted, I do not see its importance in the case report.
-I suggest replacing the analytical data documented in the case report and adding a table with all the results.
-Add literature documenting the mechanism of the adverse effect of zolendrate acid as an acute inflammatory reaction.Line 130-132.
Minor editing of English language required
Author Response
Dear reviewer, thank you for your comments
1. We agree that Zoledronic acid is not indicated as a first choice in the management of osteoporosis. This bisphosphonate was chosen by endocrinologist from the other clinic. We suppose the reason was low compliance with oral bisphosphonates in our patient. She said about difficulties with adherence to oral medications. So Zoledronic acid in this case was a first choice for effectively lowering the fracture risk
2. Unfortunately, there is only clinical guideline of the American Society of Rheumatology dedicated to osteoporosis named Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.
Endocrine Society updated its guideline on pharmacological management of osteoporosis in postmenopausal women in 2020. So we corrected introduction according this guideline.
3.We decided to mention dental disease, as we cannot exclude rare skeletal disease
4. Thank you for the suggestion to add a table with the analytical data. We decided to leave it as it was, as only a few parameters were above the normal range.The table can complicate the understanding of the text.
5. We discuss below the mechanism of the adverse effect of zoledronic acid.
Round 2
Reviewer 2 Report
I thank the authors for accepting my recommendations. I have no further requests for clarification at this time.
